Lesser Metatarsophalangeal Joints Instability: A Comprehensive Literature Review

Aim and background: Lesser metatarsophalangeal instability can result in forefoot pain and deformity. This represents a relatively common problem. Despite this, there has been little information about the main causes and management of this condition in the literature. The aim of this article is to review the current literature about the management of this problem and to highlight the role of plantar plate pathologies in pathogenesis. We also propose a management algorithm. Materials and methods: A comprehensive literature search was performed, with no time limit through PubMed, Medline, and Embase. The article abstracts were reviewed, and those that were not involving lesser metatarsophalangeal joints (MTPJs), nor in English were excluded. Results: A total of 313 articles were found by the search. After the removal of duplicates and exclusion as per methodology, 186 articles remained. We describe the anatomy of the plantar plate, clinical presentation, investigations, classification, and treatment options. We discussed the various outcome measures of different studies on this topic up to date. Conclusion: Plantar plate tears play a pivotal role in lesser metatarsophalangeal instability. Conservative management is the mainstay of initial management. If this fails, then surgical treatment is indicated. Clinical significance: We provided an up-to-date comprehensive literature review of this relatively common condition that is not fully understood.